Inpatient DRG claims hold some of the highest-value clinical and coding opportunities in payment integrity, yet many pass through traditional review workflows without every issue being caught. When your program can’t intelligently prioritize which claims to examine, meaningful savings stay buried and value walks out the door.

This case study shows how one Medicare Advantage health plan took a fresh look at claims that had already been reviewed, and uncovered more than $1M in incremental inpatient DRG savings without adding provider abrasion.

Download to learn:

• How intelligent claim selection surfaces hidden value: See how prioritizing the claims most likely to contain genuine clinical or coding issues turned 1 in 3 “no finding” audits into validated findings, proving it’s not about reviewing more claims, but reviewing the right ones.
• What precision AI delivered in four months: Understand how the plan identified $1.08M in medical expense savings, capturing $1.15 PMPM in opportunity that would have gone undiscovered, with zero appeals filed to date.
• Why transparent findings reduce disputes and abrasion: Learn how evidence-based findings letters with root-cause explanations make results more defensible, help providers correct upstream billing, and keep the payer-provider relationship intact.

See what your program might be leaving on the table, and how smarter selection can change that.